{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T22:53:42Z","timestamp":1793141622082,"version":"4.5.0"},"reference-count":54,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"\n Importance<\/jats:title>\n Head-to-head comparisons of evidence-based treatments for borderline personality disorder (BPD), including dialectical behavior therapy (DBT) and schema therapy (ST), remain scarce, despite their widely recognized relevance.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare the effectiveness of DBT and ST in a multicenter trial among outpatients with BPD.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This 3-year multicenter superiority randomized clinical trial (RCT), part of the BOOTS (Borderline Optimal Treatment Selection) project, was conducted between January 2019 and April 2025. The trial was conducted in 9 Dutch outpatient centers among individuals aged 18 to 65 years with BPD. Assessments were administered by assessors blinded to treatment allocation.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Participants were randomized to DBT or ST via computerized covariate-adaptive randomization accounting for sex and BPD severity. Both treatments were delivered over 2 years in a combined group-individual format.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n The primary outcome was the rate of change in\n DSM-5<\/jats:italic>\n BPD severity from baseline to 1-year posttreatment follow-up (3 years after baseline), assessed by the Borderline Personality Disorder Severity Index, fifth version (BPDSI-5) total score. Secondary outcomes included\n DSM-5<\/jats:italic>\n BPD criteria, general symptom severity, functioning, quality of life, well-being, sleep problems, and treatment dropout.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 204 participants (172 female [84.3%]; mean [SD] age, 32.21 [9.57] years), 95 (46.6%) received DBT and 109 (53.4%) received ST. Intention-to-treat analysis revealed no significant difference between DBT and ST in reducing BPD severity (\n P<\/jats:italic>\n \u2009=\u2009.27,\n r<\/jats:italic>\n \u2009=\u20090.09), with large improvements in both treatments. At 36-month follow-up, the estimated mean difference was \u22121.09 on the BPDSI-5 (Cohen\n d<\/jats:italic>\n \u2009=\u20090.15; 95% CI, \u22120.17 to 0.47). No significant differences between treatments were observed on any secondary outcome, with marked improvements over time in both treatments. Dropout did not differ significantly (DBT: 34% at 1 year, 52% at 2 years; ST: 29% at 1 year, 46% at 2 years).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This multicenter RCT found no significant differences in effectiveness between DBT and ST for outpatients with BPD, with substantial improvements across outcomes. Future research is warranted to assess equivalence and to determine which treatment works best for whom and why.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n https:\/\/onderzoekmetmensen.nl<\/jats:ext-link>\n Identifier:\n NL-OMON49443<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2026.0418","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T15:30:25Z","timestamp":1776871825000},"page":"669","source":"Crossref","is-referenced-by-count":2,"title":["Dialectical Behavior Therapy vs Schema Therapy for Patients With Borderline Personality Disorder"],"prefix":"10.1001","volume":"83","author":[{"given":"Carlijn J. M.","family":"Wibbelink","sequence":"first","affiliation":[{"name":"Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan H.","family":"Kamphuis","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Sinnaeve","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Mind Body Research, Katholieke Universiteit Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raoul P. P. P.","family":"Grasman","sequence":"additional","affiliation":[{"name":"Department of Psychological Methods, University of Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jet","family":"Alberts","sequence":"additional","affiliation":[{"name":"Nederlands Psychoanalytisch Instituut Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke","family":"Alkema","sequence":"additional","affiliation":[{"name":"Now with GGZ Rivierduinen, Zoetermeer, the Netherlands"},{"name":"Department of Addiction and Personality, Antes Mental Health Care, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliane C. P.","family":"Dek","sequence":"additional","affiliation":[{"name":"PsyQ Personality Disorders Rotterdam-Kralingen, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique","family":"Hupkes","sequence":"additional","affiliation":[{"name":"GGZ Noord-Holland-Noord, Heerhugowaard, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chrissy","family":"James","sequence":"additional","affiliation":[{"name":"GGZ inGeest, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annemieke M.","family":"Koppeschaar","sequence":"additional","affiliation":[{"name":"Now with PsyQ Online, Den Haag, the Netherlands"},{"name":"PsyQ Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Ploegmakers","sequence":"additional","affiliation":[{"name":"Pro Persona, Tiel, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel J.","family":"Schuur","sequence":"additional","affiliation":[{"name":"GGZ Rivierduinen, Leiden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke","family":"van Vliet","sequence":"additional","affiliation":[{"name":"Pro Persona, Ede, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnoud","family":"Arntz","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands"},{"name":"Academic Center for Trauma and Personality, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"yoi260013r1","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1002\/wps.21156","article-title":"Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies.","volume":"23","author":"Leichsenring","year":"2024","journal-title":"World Psychiatry"},{"issue":"6","key":"yoi260013r3","doi-asserted-by":"publisher","first-page":"223","DOI":"10.3390\/medicina55060223","article-title":"Suicidality in borderline personality disorder.","volume":"55","author":"Paris","year":"2019","journal-title":"Medicina (Kaunas)"},{"issue":"5","key":"yoi260013r4","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1521\/pedi_2012_26_093","article-title":"Characteristics of borderline personality disorder in a community sample: comorbidity, treatment utilization, and general functioning.","volume":"28","author":"Tomko","year":"2014","journal-title":"J Pers Disord"},{"issue":"9","key":"yoi260013r5","doi-asserted-by":"publisher","first-page":"832","DOI":"10.1002\/jclp.70000","article-title":"Burden of disease of borderline personality disorder: a comprehensive evaluation of quality of life and societal cost of illness.","volume":"81","author":"Wibbelink","year":"2025","journal-title":"J Clin Psychol"},{"issue":"1","key":"yoi260013r6","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1007\/s11920-015-0654-1","article-title":"The stigma of personality disorders.","volume":"18","author":"Sheehan","year":"2016","journal-title":"Curr Psychiatry Rep"},{"issue":"2","key":"yoi260013r12","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1521\/ijct.2013.6.2.171","article-title":"Schema therapy for personality disorders\u2014a review.","volume":"6","author":"Jacob","year":"2013","journal-title":"Int J Cogn Ther"},{"issue":"4","key":"yoi260013r13","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1001\/jamapsychiatry.2022.0010","article-title":"Effectiveness of predominantly group schema therapy and combined individual and group schema therapy for borderline personality disorder: a randomized clinical trial.","volume":"79","author":"Arntz","year":"2022","journal-title":"JAMA Psychiatry"},{"issue":"4","key":"yoi260013r14","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1159\/000538404","article-title":"The effectiveness of dialectical behavior therapy compared to schema therapy for borderline personality disorder: a randomized clinical trial.","volume":"93","author":"Assmann","year":"2024","journal-title":"Psychother Psychosom"},{"issue":"8","key":"yoi260013r15","doi-asserted-by":"publisher","first-page":"3261","DOI":"10.1017\/S0033291723000685","article-title":"Which psychotherapy is most effective and acceptable in the treatment of adults with a (sub)clinical borderline personality disorder? A systematic review and network meta-analysis.","volume":"53","author":"Setkowski","year":"2023","journal-title":"Psychol Med"},{"issue":"3","key":"yoi260013r16","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1192\/bjp.2021.204","article-title":"Psychotherapies for borderline personality disorder: a focused systematic review and meta-analysis.","volume":"221","author":"Stoffers-Winterling","year":"2022","journal-title":"Br J Psychiatry"},{"issue":"5","key":"yoi260013r17","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012955.pub2","article-title":"Psychological therapies for people with borderline personality disorder.","volume":"5","author":"Storeb\u00f8","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"issue":"10","key":"yoi260013r18","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1177\/0004867418791257","article-title":"Specialized psychotherapies for adults with borderline personality disorder: a systematic review and meta-analysis.","volume":"52","author":"Oud","year":"2018","journal-title":"Aust N Z J Psychiatry"},{"issue":"1","key":"yoi260013r19","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1186\/s12888-021-03670-9","article-title":"Towards optimal treatment selection for borderline personality disorder patients (BOOTS): a study protocol for a multicenter randomized clinical trial comparing schema therapy and dialectical behavior therapy.","volume":"22","author":"Wibbelink","year":"2022","journal-title":"BMC Psychiatry"},{"issue":"1","key":"yoi260013r20","doi-asserted-by":"publisher","DOI":"10.1525\/collabra.33267","article-title":"Sample size justification.","volume":"8","author":"Lakens","year":"2022","journal-title":"Collabra Psychol"},{"issue":"6","key":"yoi260013r21","doi-asserted-by":"publisher","first-page":"1776","DOI":"10.1038\/s41591-025-03635-5","article-title":"CONSORT 2025 statement: updated guideline for reporting randomized trials.","volume":"31","author":"Hopewell","year":"2025","journal-title":"Nat Med"},{"issue":"1","key":"yoi260013r22","doi-asserted-by":"publisher","first-page":"103","DOI":"10.2307\/2529712","article-title":"Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial.","volume":"31","author":"Pocock","year":"1975","journal-title":"Biometrics"},{"issue":"6","key":"yoi260013r23","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1016\/S0197-2456(02)00242-8","article-title":"The method of minimization for allocation to clinical trials: a review.","volume":"23","author":"Scott","year":"2002","journal-title":"Control Clin Trials"},{"issue":"5","key":"yoi260013r24","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1002\/cpt1974155443","article-title":"Minimization: a new method of assigning patients to treatment and control groups.","volume":"15","author":"Taves","year":"1974","journal-title":"Clin Pharmacol Ther"},{"issue":"1","key":"yoi260013r27","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1521\/pedi.17.1.45.24053","article-title":"Reliability and validity of the borderline personality disorder severity index.","volume":"17","author":"Arntz","year":"2003","journal-title":"J Pers Disord"},{"issue":"2","key":"yoi260013r28","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1016\/j.paid.2010.03.023","article-title":"The Borderline Personality Disorder Severity Index-IV: psychometric evaluation and dimensional structure.","volume":"49","author":"Giesen-Bloo","year":"2010","journal-title":"Pers Individ Dif"},{"key":"yoi260013r29","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2025.152656","article-title":"Efficient screening and outcome assessment for borderline personality disorder: A psychometric evaluation of the uBPDc.","volume":"145","author":"Wibbelink","year":"2026","journal-title":"Compr Psychiatry"},{"issue":"3","key":"yoi260013r30","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1017\/S0033291700048017","article-title":"The Brief Symptom Inventory: an introductory report.","volume":"13","author":"Derogatis","year":"1983","journal-title":"Psychol Med"},{"issue":"10","key":"yoi260013r32","doi-asserted-by":"publisher","first-page":"1727","DOI":"10.1007\/s11136-011-9903-x","article-title":"Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L).","volume":"20","author":"Herdman","year":"2011","journal-title":"Qual Life Res"},{"issue":"2","key":"yoi260013r33","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1007\/s11136-021-02935-w","article-title":"The Mental Health Quality of Life Questionnaire (MHQoL): development and first psychometric evaluation of a new measure to assess quality of life in people with mental health problems.","volume":"31","author":"van Krugten","year":"2022","journal-title":"Qual Life Res"},{"issue":"2","key":"yoi260013r34","doi-asserted-by":"publisher","first-page":"139","DOI":"10.2224\/sbp.2006.34.2.139","article-title":"Measuring happiness with a single-item scale.","volume":"34","author":"Abdel-Khalek","year":"2006","journal-title":"Soc Behav Personal"},{"issue":"2","key":"yoi260013r35","first-page":"91","article-title":"The outcome rating scale: a preliminary study of the reliability, validity, and feasibility of a brief visual analog measure.","volume":"2","author":"Miller","year":"2003","journal-title":"J Brief Ther"},{"issue":"4","key":"yoi260013r36","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1016\/S1389-9457(00)00065-4","article-title":"Validation of the Insomnia Severity Index as an outcome measure for insomnia research.","volume":"2","author":"Bastien","year":"2001","journal-title":"Sleep Med"},{"issue":"4","key":"yoi260013r37","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1023\/A:1007854015481","article-title":"A controlled study of imagery rehearsal for chronic nightmares in sexual assault survivors with PTSD: a preliminary report.","volume":"13","author":"Krakow","year":"2000","journal-title":"J Trauma Stress"},{"issue":"2","key":"yoi260013r38","doi-asserted-by":"publisher","DOI":"10.2478\/bile-2022-0010","article-title":"Structures of the covariance matrix: an overview.","volume":"59","author":"Janiszewska","year":"2022","journal-title":"Biom Lett"},{"issue":"3","key":"yoi260013r39","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1037\/ccp0000803","article-title":"Is personalized treatment selection a promising avenue in bpd research? A meta-regression estimating treatment effect heterogeneity in RCTs of BPD.","volume":"91","author":"Kaiser","year":"2023","journal-title":"J Consult Clin Psychol"},{"issue":"11","key":"yoi260013r40","doi-asserted-by":"publisher","first-page":"1829","DOI":"10.1017\/S0033291720000550","article-title":"Treatment selection in borderline personality disorder between dialectical behavior therapy and psychodynamic psychiatric management.","volume":"51","author":"Keefe","year":"2021","journal-title":"Psychol Med"},{"issue":"1","key":"yoi260013r41","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1146\/annurev-clinpsy-050817-084746","article-title":"Treatment selection in depression.","volume":"14","author":"Cohen","year":"2018","journal-title":"Annu Rev Clin Psychol"},{"issue":"1","key":"yoi260013r42","doi-asserted-by":"publisher","first-page":"93","DOI":"10.3390\/jpm12010093","article-title":"The contribution of \u201cindividual participant data\u201d meta-analyses of psychotherapies for depression to the development of personalized treatments: a systematic review.","volume":"12","author":"Cuijpers","year":"2022","journal-title":"J Pers Med"},{"key":"yoi260013r43","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2025.102089","article-title":"A theoretical perspective on the role of sleep in borderline personality disorder: from causative factor to treatment target.","volume":"81","author":"van Trigt","year":"2025","journal-title":"Sleep Med Rev"},{"issue":"4","key":"yoi260013r44","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1017\/S2045796016000809","article-title":"Pre-post effect sizes should be avoided in meta-analyses.","volume":"26","author":"Cuijpers","year":"2017","journal-title":"Epidemiol Psychiatr Sci"},{"issue":"1","key":"yoi260013r45","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1186\/s13063-023-07596-3","article-title":"Evaluation of randomized controlled trials: a primer and tutorial for mental health researchers.","volume":"24","author":"Harrer","year":"2023","journal-title":"Trials"},{"issue":"3","key":"yoi260013r46","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1017\/S0033291722003634","article-title":"Dropout from psychological treatment for borderline personality disorder: a multilevel survival meta-analysis.","volume":"53","author":"Arntz","year":"2023","journal-title":"Psychol Med"},{"issue":"3","key":"yoi260013r47","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1080\/16506073.2019.1620324","article-title":"A systematic review and meta-analysis of dropout rates from dialectical behaviour therapy in randomized controlled trials.","volume":"49","author":"Dixon","year":"2020","journal-title":"Cogn Behav Ther"},{"issue":"6","key":"yoi260013r48","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1037\/a0021015","article-title":"Dialectical behavior therapy for borderline personality disorder: a meta-analysis using mixed-effects modeling.","volume":"78","author":"Kliem","year":"2010","journal-title":"J Consult Clin Psychol"},{"issue":"3","key":"yoi260013r49","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1037\/a0037512","article-title":"A treatment by disorder meta-analysis of dropout from psychotherapy.","volume":"24","author":"Swift","year":"2014","journal-title":"J Psychother Integration"},{"issue":"3","key":"yoi260013r50","doi-asserted-by":"publisher","DOI":"10.1002\/cpp.70080","article-title":"Dropout in psychotherapy for personality disorders: a systematic review of predictors.","volume":"32","author":"De Salve","year":"2025","journal-title":"Clin Psychol Psychother"},{"issue":"6","key":"yoi260013r51","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1080\/10503307.2014.883087","article-title":"Dropout revisited: patient- and therapist-initiated discontinuation of psychotherapy as a function of organizational instability.","volume":"24","author":"Werbart","year":"2014","journal-title":"Psychother Res"},{"issue":"4","key":"yoi260013r52","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1002\/pmh.1381","article-title":"Implementation of evidence-based treatments for borderline personality disorder: the impact of organizational changes on treatment outcome of mentalization-based treatment.","volume":"11","author":"Bales","year":"2017","journal-title":"Personal Ment Health"},{"issue":"6","key":"yoi260013r53","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1037\/0022-006X.75.6.829","article-title":"Treatment integrity in psychotherapy research: analysis of the studies and examination of the associated factors.","volume":"75","author":"Perepletchikova","year":"2007","journal-title":"J Consult Clin Psychol"},{"issue":"1","key":"yoi260013r54","doi-asserted-by":"publisher","first-page":"950","DOI":"10.1186\/s12888-024-06366-y","article-title":"Particular vulnerability of patients with borderline personality disorder during the COVID-19 pandemic\u2014a retrospective chart review.","volume":"24","author":"Kippe","year":"2024","journal-title":"BMC Psychiatry"},{"key":"yoi260013r2","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","author":"American Psychiatric Association","year":"2013","edition":"5th ed"},{"key":"yoi260013r7","volume-title":"DBT Skills Training Handouts and Worksheets","author":"Linehan","year":"2014","edition":"2nd ed"},{"key":"yoi260013r8","volume-title":"DBT Skills Training Manual","author":"Linehan","year":"2015","edition":"2nd ed"},{"key":"yoi260013r9","doi-asserted-by":"crossref","DOI":"10.1002\/9781119101161","volume-title":"Schema Therapy for Borderline Personality Disorder","author":"Arntz","year":"2020"},{"key":"yoi260013r10","volume-title":"Schema Therapy: A Practitioner\u2019s Guide","author":"Young","year":"2006"},{"key":"yoi260013r11","volume-title":"Cognitive-Behavioral Treatment of Borderline Personality Disorder","author":"Linehan","year":"1993"},{"key":"yoi260013r25","doi-asserted-by":"crossref","DOI":"10.1002\/9781119943167","volume-title":"Group Schema Therapy for Borderline Personality Disorder: A Step-by-Step Treatment Manual with Patient Workbook","author":"Farrell","year":"2012"},{"key":"yoi260013r26","author":"van Leeuwen","year":"2017"},{"key":"yoi260013r31","volume-title":"Measuring Health and Disability: Manual for WHO Disability Assessment Schedule WHODAS 2.0","author":"\u00dcst\u00fcn","year":"2010"}],"container-title":["JAMA Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamapsychiatry\/articlepdf\/2848044\/jamapsychiatry_wibbelink_2026_oi_260013_1782743866.45608.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T15:06:00Z","timestamp":1782918360000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamapsychiatry\/fullarticle\/2848044"}},"subtitle":["The BOOTS Multicenter Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":54,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamapsychiatry.2026.0418","relation":{},"ISSN":["2168-622X"],"issn-type":[{"value":"2168-622X","type":"print"}],"subject":[],"published":{"date-parts":[[2026,7,1]]}}}